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EARLY DETECTION

Table 1: 5-year age-standardized relative survival (ASRS %) by country

(VIA) and visual screening with Lugol’s iodine (VILI) can be

and cancer site administered to women between the ages of 30–50 at the

Breast Cervix primary care level if the health centres are equipped with

USA 89.0% 67.8% facilities for pelvic examination and necessary consumables.

China 82.5% 67.0% The primary care practitioners can be readily trained in

Costa Rica 69.6% 53.5%

performing these tests and in interpreting the real time test

Cuba 70.4% 56.3%

results competently in short in-service training courses or by

India 51.6% 46.4%

Philippines 47.4% 37.4% self-learning using manuals, atlases and digital training

Republic of Korea 78.6% 79.2% courses6,7.

Saudi Arabia 64.5% Visual screening tests are the most feasible cervical

Singapore 76.4% 65.7% screening tests that can be administered at the primary care

Thailand 62.8% 60.7%

level, since they do not require a laboratory infrastructure, and

The Gambia 12.5% 21.8%

consumables such as 3–5% dilute acetic acid and Lugol’s

Turkey 77.2% 63.5%

Uganda 45.9% 13.1% iodine can be readily made available in health centres and the

Zimbabwe 57.8% 39.1% test results are interpreted in real time. If a definite

acetowhite area is detected on the cervix 1-minute after the

Source: Sankaranarayanan R et al. Cancer survival in Africa, Asia, the Caribbean and

Central America (SurvCan). IARC Scientific Publications volume 162, Lyon, IARC, 2011. application of acetic acid, VIA testing is positive and if a well-

US National Cancer Institute. Surveillance Epidemiology and End Results (US SEER)

http://surveillance.cancer.gov/statistics/types/survival.html

defined mustard-yellow area appears on the cervix after

application of Lugol’s iodine, VILI testing is positive; VIA- or

to promote early clinical diagnosis and treatment. We plan to VILI-positive women have a high probability of harbouring

cover early diagnosis of other cancer sites at the primary high-grade cervical intraepithelial neoplasia (CIN II or III),

health care level in future editions. which are cervical cancer precursor lesions. Detecting and

effectively treating CIN II and III lesions will result in the

The role of primary health care services in early detection prevention of subsequent invasive cancer among these

Effective cancer early detection efforts at the primary care women. In a setting where there are no resources for directing

level is critically important for the success of clinical early biopsies, colposcopy and histopathology services in secondary

diagnosis efforts, since more than 90% of patient contacts care such as is the case in many sub-Saharan African countries,

within any health care system in the world occur at the VIA- and/or VILI-positive women without clinical features

primary care level in health centres, dispensaries and in the suggestive of invasive cancer may be treated using

offices of general and family practitioners. Millions of people cryotherapy or cold coagulation without further

interact with primary care services on a daily basis, which investigations, in a “screen and treat” mode8,9. The safety,

provides a highly useful platform within health services to acceptability and efficacy of the screen and treat approach in

improve population awareness of common cancers, to preventing CIN has been well documented in less-developed

provide simple screening tests and refer clinically suspect countries8-10. In settings where there is capacity for further

patients for diagnosis and treatment in the secondary or investigations, patients may be referred to secondary care

tertiary care levels as deemed appropriate, provided the facilities where colposcopy, biopsy and further management

doctors, nurses and health workers at the primary care level can be carried out11-13. Women with negative VIA or VILI tests

are knowledgeable and competent to provide these may be advised a repeat screening after 3–5 years.

interventions amidst their routine responsibilities. Prompt In settings where there are facilities for performing Pap

recognition of symptoms and signs that may give an early smear or HPV testing, women above the age of 30 years, who

warning of cancer, however, should also trigger an informed can afford them, may be advised of these tests; those with

and empowered lay individual to seek medical care. Most atypia or worse results on Pap smear or testing positive for

cancers could be detected earlier if the index of suspicion of HPV infection should be referred for investigations and

cancer on the part of primary health care workers was higher, treatment. A single baseline HPV-negative test in women

particularly when providing routine care for persons known above the age of 30 has a high negative predictive value for

to be at high risk for cancer. subsequent cervical neoplasia and thus has an extremely low

risk of invasive cancer or CIN in the next 7–10 years or so14,15.

Early detection of cervical cancer in primary care Women presenting in primary care services may be

Early detection tests such as visual screening with acetic acid routinely asked if they suffer from symptoms such as abnormal

CANCER CONTROL 2013 69

Index

  1. CANCER CONTROL 2013
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